Effectiveness is the gold standard of clinical research

Psychological treatments have been shown to be at least as effective (and sometime even more effective) than psychotropic medications for many psychiatric disorders, in particular anxiety disorders, depressive disorders, and personality disorders (American Psychological Association, 2013; Cuijpers, 2017). Effective psychological treatments are also cost-effective: their implementation in public mental health services is convenient in financial terms, with decades of studies consistently demonstrating a reduction in public spending for psychological health (Abbass, Kisely, Rasic, Town & Johansson, 2015). Therefore, it could be critical that psychological treatments whose efficacy is supported by strong empirical evidence can be delivered as a primary choice in public mental health services. We hope and believe that the time when a psychologist or a psychiatrist (especially if paid by the public mental health system) could provide any treatment he or she thought fit, even in the absence of any scientific evidence of its efficacy, is coming to an end. However, a recommendation should be made to be very careful in not equating the empirical support of a given treatment with the sole presence of randomized controlled trials (RCTs) that show its efficacy. This would be a mistake from both an empirical and a theoretical perspective, as it runs the risk of throwing out the baby with the bathwater. In other words, endorsing a perspective according to which a specific treatment should be promoted or rejected on the sole basis of findings from RCT studies runs the risk of putting clinical science back almost twenty years from the current more advanced understanding of the efficacy, effectiveness, and usefulness of psychotherapy (Dazzi, 2006; Dazzi, Lingiardi, & Colli, 2006; Leichsenring et al., 2016; Silberschatz, 2017).